MEDICARE: BIRTH STEWART ORAL SURGERY ARLINGTON PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	11736	TX
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	17519	TX

General Provider Information

NPI Number	:	1053743591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRTH STEWART ORAL SURGERY ARLINGTON PLLC

Provider Business Mailing Address
First Line	:	2011 W BARDIN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1654
Country	:	US
Telephone Number	:	817-557-0025
Fax Number	:	817-557-1916

Provider Business Practice Location Address
First Line	:	2011 W BARDIN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1654
Country	:	US
Telephone Number	:	817-557-0025
Fax Number	:	817-557-1916

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. CHARLES STEWART
Credential	:	DDS
Telephone Number	:	817-557-0025

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	11/04/2013

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